As the year closes, many OTs are juggling exhaustion, rising referrals, shifting NDIS rules and pressure from both paediatric and adult caseloads. The overlapping demands can feel chaotic, yet they share common themes that help explain why so many clinicians are feeling stretched.

When recovery time disappears

After conferences or big clinical weeks, many OTs return home depleted, only to find their calendars already full. Some practitioners restore energy through activity and constant movement, while others need slow days, naps or quiet routines. However you recharge, the year’s end highlights how little structured downtime most clinicians give themselves. More OTs are now blocking recovery days after conferences or travel, recognising it as essential rather than indulgent.

The familiar end of year surge in NDIS work

While families start winding down in November, NDIS referrals often spike. OTs are fielding urgent equipment requests, last minute home mod deadlines and frantic plan review preparation. Many are returning from brief leave to find complex home mods incorrectly declined or paperwork misplaced, forcing them to spend precious clinical time fixing administrative errors. This mismatch between urgency and system reliability is becoming one of the biggest contributors to burnout.

Escalations, external reviews and the shifting ART landscape

A pattern is emerging in complex cases. Once an ART application is lodged, some matters are being intercepted by an NDIA external review group that checks whether the dispute can be resolved without a full hearing. In several cases, the Technical Advisory Branch has stepped in to clarify details or review clinical reasoning, leading to new plans being issued quickly. Although far from consistent, this pathway has saved some participants months of delay. The downside is that it still depends heavily on OTs providing clear explanation, extra evidence or recorded walkthroughs, adding to already stretched workloads.

Staffing growth, fraud focus and inconsistent decision making

NDIA staffing numbers have grown sharply, yet the quality of decision making has not improved proportionately. Considerable money has been channeled into fraud investigations with modest results. At the same time, the scrutiny placed on participants and providers continues to intensify. The gap between the agency’s internal overspending and the tight control expected of participants is feeding frustration among clinicians who face constant checks, queries and payment delays.

Alternate therapies and the renewed push for quality supports

Confusion about what constitutes therapy persists. Non-allied health businesses continue marketing high cost interventions, such as hyperbaric oxygen sessions, as NDIS-fundable “therapy”. These practices directly conflict with the NDIA’s Quality Supports for Children resource, which outlines what good practice looks like and what families should question. For paediatric OTs, it is a timely reminder to ground recommendations in evidence, communicate clearly with families and redirect them away from interventions that do not meet reasonable and necessary criteria.

Compliance expectations across sectors

OTs supporting NDIS participants must comply with the NDIS Code of Conduct whether registered or not. The NDIS Worker Screening Check does not replace a Working With Children Check, although it can now meet screening requirements in some aged care roles. As payment integrity checks increase, clinicians need clear documentation, fee transparency and consistent processes, because the assumption that non-registered providers are exempt from obligations is no longer sustainable.

Fraud crackdowns and looming system changes

Government announcements signal further tightening around NDIS fraud, including closing payment blind spots and strengthening oversight. While details are pending, similar reforms have historically meant greater surveillance and more administrative burden for clinicians. OTs can expect ongoing payment checks and heightened interest in how decisions are justified.

Thriving Kids uncertainty in paediatric practice

Paediatric OTs face additional pressure from the proposed Thriving Kids reforms, which have met strong resistance from states and territories. Conflicting messages and limited clarity make strategic planning difficult. Some services are preparing for major shifts while others are holding steady. Clinicians involved in advisory groups are working to ensure evidence-based, accessible programs shape the final model, but timelines remain unpredictable.

Support Needs Assessments and their consequences

The proposed Support Needs Assessments are generating intense concern. They involve a structured conversation rather than allied health evidence, assessors may not be clinicians, and participants cannot review or correct the resulting report. Because the report will determine a single total budget, the only available review pathway appears to be requesting a completely new Support Needs Assessment. This creates a clear conflict of interest and reduces transparency. For OTs, the implications for functional assessments, reasoning and advocacy are significant.

Paediatric caseload rhythms at year’s end

Paediatric services face a different pattern to adult work. Families often avoid beginning therapy late in the year, supervision drops away and school access planning for next year becomes a priority. The final few sessions before shutdown can feel insignificant, yet reframing them as a short, purposeful block can help clinicians end the year with direction rather than drift.

Planning for next year in an unstable landscape

Clinicians who manage the year’s end most effectively tend to plan early, protect rest, stay selectively informed about reforms and avoid spreading themselves across every debate. For business owners, mapping school terms, public holidays and known conferences creates structure, while deliberately reserving breaks helps prevent the creeping normalisation of overwork.

Key takeaways for OTs

If you need additional guidance on navigating NDIS complexity, paediatric practice design or sustainable business systems, connecting with OT-focused learning communities can provide clarity and support as the sector continues to shift.